Full-Thickness Facial Pressure Injury and Buried Dentition from Prone Positioning in a Patient with COVID-19

Conlon, Christopher P.; Slovacek, Cedar; Jalalabadi, Faryan; Winocour, Sebastian; Olorunnipa, Olushola

doi:10.1097/01.asw.0000749796.16178.7b

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Reforçando essa ideia, pesquisas apontam que a mudança de decúbito concomitante ao uso de distribuidores de pressão do corpo bem como curativos profiláticos para a pele, podem beneficiar pacientes propensos a lesões de pele e reduzir as complicações durante o internamento 10,14 .…”

Section: Resultsunclassified

Covid-19: Um Resgate Bibliográfico Sobre Práticas Exitosas Na Prevenção De Lesões Por Pressão

Araújo

Soares²

2022

REV. CIÊNC. PLURAL

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Introdução: Em dezembro de 2019 na China, o SARS-CoV-2 foi identificado e declarado como pandemia pela Organização Mundial da Saúde. Sua transmissibilidade entre humanos e evolução com estabilidade clínica e hemodinâmica, aumentam o risco do desenvolvimento de lesões por pressão nos pacientes mais críticos. Objetivo: Identificar os principais cuidados hospitalares para manter a integridade da pele nos pacientes com Covid-19 propensos a lesão por pressão. Metodologia: Estudo descritivo do tipo revisão integrativa realizado nas bases: Literatura Latino-Americana de Ciências da Saúde, Base de Dados de Enfermagem, Scientific Eletronic Library Online e Biblioteca Nacional de Medicina dos Estados Unidos com os descritores Covid-19, Lesão por pressão, Assistência ao paciente e Padrões de referência. Os critérios de inclusão foram textos completos disponíveis gratuitamente, publicados entre 2019 e 2021, que compartilhassem da temática em adultos e/ou idosos. Foram excluídos artigos incompletos, plataformas pagas, carta e notas editor, reflexões e os artigos duplicados foram contabilizados uma vez, o idioma de origem não foi fator excludente. Resultados: Foram identificados 398 artigos potencialmente relevantes e 7 foram selecionados. As principais práticas relacionadas a prevenção de lesões por pressão em pacientes com COVID-19 apontam intervenções como o uso de checklist, avaliação periódica da pele, definição do risco de desenvolvimento de lesão por pressão, mudança de decúbito conforme tolerância do paciente, uso de superfície para redistribuição de peso, cobertura profilática multicamadas e controle da umidade da pele. Conclusões: As principais práticas para evitas as lesões por pressão nos pacientes com Covid-19 no ambiente hospitalar estão associadas com o cuidado direto ou indiretamente ligados a pele, adoção de medidas preventivas e sistemáticas dentro da realidade clínica e hemodinâmica dos pacientes.

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Section: Resultsunclassified

Covid-19: Um Resgate Bibliográfico Sobre Práticas Exitosas Na Prevenção De Lesões Por Pressão

Araújo

Soares²

2022

REV. CIÊNC. PLURAL

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“…Whereas PP has shown to be beneficial in patients with severe ARDS induced by COVID-19 or non-COVID-19 pneumonia, it is not without complications. [47][48][49][50][51][52] In 2021, Gonzalez-Sequel et al 53 conducted a scoping review to identify AEs related to PP in subjects with ARDS requiring mechanical ventilation. Of the 41 studies included in their review, 15 (36.6%) included subjects with COVID-19 ARDS.…”

Section: Complications Associated With Prone Positioningmentioning

confidence: 99%

“…The intent of this so-called swimmer's position is to reduce facial pressure injuries, provide access to intravenous lines, and allow for visual assessments. 52 Acknowledging the importance of PP, but the reality that injury is likely to occur, Simpson et al 49 provided a set of concise recommendations to reduce brachial plexus injury Conduct and document pressure point assessment Promote early mobilization Capasso et al 61 Consider impact of oxygen deficits on the risk of pressure injuries Determine repositioning frequency, with consideration of patient factors Reposition to off-load bony prominences and redistribute pressure Use soft-silicone multilayered foam dressings Use prophylactic dressings beneath medical devices PP ¼ prone positioning based on findings from the available literature. For patients placed in the prone position, they suggest (1) slide the scapulae up the back with a slight shoulder shrug to avoid depression of the shoulder girdle, (2) maintain straight spine alignment to avoid excessive rotation, (3) avoid extension of the shoulder or subluxation of the shoulder joint dorsally, (4) avoid abduction of the arm beyond 70 with elbow extension and external rotation of the shoulder more than 60 , (5) avoid neck extension, and (6) reduce venous pressure in the thoracic outlet and neck by avoiding abdominal compression.…”

Section: Complications Associated With Prone Positioningmentioning

confidence: 99%

COVID-19 Lessons Learned: Prone Positioning With and Without Invasive Ventilation

Scott

Weiss

2022

Respir Care

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Prone positioning (PP) has been used extensively for patients requiring invasive mechanical ventilation for hypoxemic respiratory failure during the COVID-19 pandemic. Evidence suggests that PP was beneficial during the pandemic, as it improves oxygenation and might improve chances of survival, especially in those with a continuum of positive oxygenation responses to the procedure. Additionally, the pandemic drove innovation regarding PP, as it brought attention to awake PP (APP) and the value of an interdisciplinary team approach to PP during a pandemic. APP appears to be safe and effective at improving oxygenation; APP may also reduce the need for intubation in patients requiring advanced respiratory support like high-flow nasal cannula or noninvasive ventilation. Teams specifically assembled for PP during a pandemic also appear useful and can provide needed assistance to bedside clinicians in the time of crisis. Complications associated with PP can be mitigated, and a multidisciplinary approach to reduce the incidence of complications is recommended.

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“…In the critical care setting, patients with ARDS and related conditions are often mechanically ventilated and placed in the prone position to further assist with increasing oxygen exchange to maximize ventilation and perfusion 6,7. During the global pandemic, as many as 67% of COVID-19 patients developed ARDS; this life-threatening complication carries a reported mortality rate of up to 40% 8,9. A 2023 study of mortality data during the first year of the COVID 19 pandemic in the United States reported an approximately 5-fold increase in deaths attributed to ARDS 10.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 During the global pandemic, as many as 67% of COVID-19 patients developed ARDS; this life-threatening complication carries a reported mortality rate of up to 40%. 8,9 A 2023 study of mortality data during the first year of the COVID 19 pandemic in the United States reported an approximately 5-fold increase in deaths attributed to ARDS. 10 From 2014 to 2019, ARDS-related mortality in the United States averaged 10,500 deaths per year, but this rate increased to 51,184 in 2020.…”

Section: Introductionmentioning

confidence: 99%

Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit

Hughes

2023

Journal of Wound, Ostomy &Amp; Continence Nursing

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PURPOSE: The purpose of this quality improvement (QI) initiative was to evaluate the effects of a repositioning intervention bundle on the occurrences and severity of hospital-acquired pressure injuries (HAPIs) of the face in patients with COVID-19–related acute respiratory distress syndrome (ARDS) managed by ventilation and placed in a prone position. PARTICIPANTS AND SETTING: Eighteen critically ill, ventilated patients were placed in a prone position for extended periods (range, 1-13 days). The study setting was critical care units in a 504-bed nonprofit teaching hospital located in the Northeastern United States. APPROACH: Standard of care for the prevention of pressure injury (PI) in ventilated patients placed in a prone position at our facility included use of foam dressings over bony prominences on the face and the application of tape to secure the endotracheal (ET) tube as compared to commercial ET tube securement devices. We also placed a fluidized pillow with pillowcase wrapped with an absorbent pad under the head to absorb secretions. We added 2 interventions to our facility's existing HAPI prevention bundle. The first was a repositioning strategy; ventilated and prone patients were lifted by their shoulders by critical care RNs while their ET tube was stabilized by a respiratory therapist every 6 hours. The RNs then repositioned the patient's head and arms to the opposite side into a swimmer's position (head lying to the side with one cheek in contact with the fluidized pillow). The second intervention was micromovement of the head performed by an RN every 4 hours. OUTCOMES: Prior to implementation of the QI initiative, data collected during the early pandemic demonstrated that multiple patients developed facial PIs secondary to prone positioning; a majority were full-thickness or unstageable PIs, whereas a minority were partial-thickness PIs (stage 2). Following implementation of the QI initiative, data indicated that 5 of 18 (28%) patients placed in a prone position had HAPIs of the face; 4 (22%) of the HAPIs were stage 1 or 2 and 1 was unstageable. Patients were placed in a prone position from 1 to 13 days. All facial HAPIs developed within the first 2 days of placement in a prone position. IMPLICATIONS FOR PRACTICE: The addition of an RN and a respiratory therapist repositioning intervention and micromovements of the head every 4 hours by the RN to an existing pressure prevention bundle during prone positioning led to a clinically relevant reduction in the severity of facial HAPIs. As a result, care for these patients has been changed to incorporate the repositioning interventions implemented during this QI project.

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Full-Thickness Facial Pressure Injury and Buried Dentition from Prone Positioning in a Patient with COVID-19

Cited by 5 publications

References 7 publications

Covid-19: Um Resgate Bibliográfico Sobre Práticas Exitosas Na Prevenção De Lesões Por Pressão

Covid-19: Um Resgate Bibliográfico Sobre Práticas Exitosas Na Prevenção De Lesões Por Pressão

COVID-19 Lessons Learned: Prone Positioning With and Without Invasive Ventilation

Reducing Facial Hospital-Acquired Pressure Injuries Related to Prone Positioning in the Intensive Care Unit

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